Posted on 04/18/2010 7:49:12 AM PDT by AJFavish
To give you an idea of just one part of the chaos that the Dems have inflicted with the health control bill, here is a brief summary from a legal treatise of one small aspect of insurance law in California. As you will see, to force an insurer to provide coverage for a condition that pre-existed the beginning of the coverage, is to force the insurer to provide something that is not "insurance" as that term is presently defined in California, and probably in every other jurisdiction.
Insurance is designed to protect against contingent or unknown risks of harm, not risks that are certain or expected or harms that have already occurred: “The concept of ‘fortuity’ is basic to insurance law.” [Chu v. Canadian Indem. Co., 224 Cal.App.3d 86, 94–95(1990); see Oak Park Calabasas Condominium Ass'n v. State Farm Fire & Cas. Co., 137 Cal.App.4th 557, 565 (2006).
By statute, “any contingent or unknown event, whether past or future, which may damnify a person having an insurable interest, or create a liability against him, may be insured against ... ” California Insurance Code § 250. However, no one can insure against a risk that is known or apparent (e.g., settling of residence after earth movement has become manifest). See Prudential-LMI Commercial Ins. v. Sup.Ct. (Lundberg), 51 Cal.3d 674, 695 (1990). This is known as the “loss in progress” or “known loss” rule.
As being a dog is a pre-existing condition, I think veterinary care needs to be covered, as well.
It depends on how ‘pre-existing condition’ is defined.
Suppose you have a bit of tendonitis in your ankle, and fail to disclose it. Then, ten years later, you can get a brain tumor, and they will deny you coverage because you failed to disclose your ankle problem.
Nearly everyone has some minor health issues.
I want t drop my auto insurance and pick it back up when I have a pre-existing condition of having my front end crumpled inward.
American Health Insurance Denied to Obummer for Pre-Existing Kenyan Condition [born in Africa] besides being a Moron
If people want to set up something on a prepaid basis, like an annuity that will pay out from the interest from a trust fund, or amortize that trust fund over a period of years with a decreasing balance until the fund is fully expended, that is an entirely different financial instrument from “insurance”, which is a bet you make with the insurance company on a continuing basis, that a certain set of circumstances WILL happen, and the insurance company is betting it WON’T happen.
In the long run, insurance companies are profitable, using this formula.
You can play linguistic games with this all you want. The fact is if you force “insurance” to cover preexisting conditions, AND force them to charge the same rates they charge everyone else, you will either drive the rates up to atmospheric levels, or bankrupt the insurers.
AuschwitzCare is the reality of this genocide of the elderly cooked up and brought to you by Zero, Pelosi, Reid, et al. in this reprehensible Congress.
I want insurance for pre-crashed cars then I could buy junkers for $500 and turn them into new cars, its only FAIR.
OK, look at me. I’m 56, I’ve had an ulcer, knee surgery, foot surgery, and a melanoma removed.
I feel pretty good right now, and work out in the gym twice a week and walk two miles a day. No known health issues, although ankles and knees are not great.
If a health insurer takes me, he gets a pretty healthy risk. But, one the other hand, a knee might go or another ulcer might pop up. That’s the way it is with 56-year-old guys.
My own opinion is that it is not really insurance. It is a combination of insurance and pre-payment of needed services. The two aspects of it do not really get on very well together.
If you control the language, you control the debate. "AuschwitzCare" would have been a good name to apply the the abomination in the days before its passage.
Wouldn’t it make sense to charge a premium for a pre-existing condition, based on typical future costs for such a condition?
Oh, that is what the market WAS doing, until liberals tampered with the formula.
Now, we ALL will have to pay for other people’s pre-existing conditions, regardless of cause.
So why take care of yourself? Why exercise? Why have protected sex?
Any diseases you get and need to be treated will be cost-shared with the rest of the nation.
Corporations have never been obligated to issue contracts to anyone in this country who was willing to try and secure said contract by deceptively representing a lack of existing conditions that would lead a corporation, or any individual, to reject, or modify said contract.
The laws of states have almost uniformly, since the founding of the U.S., allowed any such ill-gotten contract to be rescinded upon discovery of such misrepresentation, intentional, or not!!!
Most health insurance/health plan contracts specify conditions and time periods for which there will be no coverage in any event and the applicant is usually made aware of any such "limitations and exclusions!" Without these, it's is generally impossible to actuarily determine how much to charge for the risk being assumed so at least a time cushion is provided the insurer to allow reserving for early claims.
Most starry eyed, emotion driven liberals just can't seem to comprehend this basic fact of contract law!!!
This is what government run Medicare and social security are. Of course the government spent all the money on other things and now they are bankrupt. The private insurance industry is solvent and turning a 3% profit. This must be stopped. We must bankrupt the entire health system as soon as possible.
bookmarked for argument ammo.
I agree, at some point as people age health issues arise. I mean really if insurance is going to cover somebody getting the flu, a cold, a sprain from sports, a broken leg, etc. All this is covered by insurance. We know a certain percentage of the population will have ongoing catastrophic health issues and many will get worse as they age.
What is health insurance? We are all going to get sick, injured, and die.
But that would depend on whether the non-disclosure is material, wouldn’t it?
If they ask you if you ever had an ulcer, and you lie, that invalidates the contract.
If they ask you if you have had any other significant health problems, then the question of which such conditions are ‘significant’, and which are not, would be raised by the insured’s attorney.
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